Basic Information
| Provider Information | |||||||||
| NPI: | 1750701199 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SEI ANESTHESIA PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4107 | ||||||||
| Address2: | |||||||||
| City: | POCATELLO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832054107 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082338880 | ||||||||
| FaxNumber: | 2082321950 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 N 18TH AVE | ||||||||
| Address2: | BLDG A | ||||||||
| City: | POCATELLO | ||||||||
| State: | ID | ||||||||
| PostalCode: | 832013358 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082338880 | ||||||||
| FaxNumber: | 2082321950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2014 | ||||||||
| LastUpdateDate: | 09/15/2015 | ||||||||
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| AuthorizedOfficialLastName: | SNELL | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2085300216 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.